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We randomized 64 patients with a history of recurrent urinary tract infections among 3 regimens of long-term (1 year) prophylactic treatment: 20 were given 100 mg. trimethoprim at night, 25 received 1,000 mg. methenamine hippurate every 12 hours and 19 were asked to cleanse the perineum (especially the periurethral area) twice daily with povidone-iodine solution. The progress of patients in terms of urinary symptoms and/or bacteriuria, changes in periurethral flora, side effects, and hematological and biochemical profiles was followed at regular intervals. All treatments were effective in reducing the incidence of symptomatic attacks when compared to the 12 months immediately before therapy and there was little to choose between the individual regimens on this account. However, trimethoprim was tolerated better than were the other 2 treatment regimens. In the group given trimethoprim most of the breakthrough infections (71.4 per cent) that occurred were caused by trimethoprim-resistant organisms (usually Escherichia coli), while in the other 2 groups the incidence of trimethoprim-resistant organisms causing infection was low (2.7 per cent). Treatment with trimethoprim reduced significantly the periurethral colonization of Escherichia coli.

SUMMARY A six test biotyping system comprising fermentation of dulcitol, sorbose, raffinose, and 5 ketogluconate, motility and production of P-haemolysis was used to obtain biotype profiles for 514 strains of Escherichia coli isolated from the urinary tract. This profile was suffixed to the API-20E code, recorded when the strains were originally identified. An expanded and reliable biotyping system was thus created giving a greater number of possible biotypes than with either system alone. The sensitivity in terms of distinguishing the organisms studied was therefore greatly increased. For a biotyping test to be maximally discriminatory 50% of strains must be positive and 50% negative and there are few simple tests that fulfil this basic criterion. However, for practical purposes, tests which are less than ideal have been shown to be suitable. Crichton and Old' in a comprehensive study established a number of tests which were suitable and proved reliable for biotyping E coli. A few of these tests are included in the API-20E system (API Laboratory Products Ltd) for the identification of Enterobacteriaceae. Since in this laboratory all coliforms are identified by the API-20E system our approach was to make it the basis for further biotyping. Thus to the API code were added the results of six further biotyping tests in order to expand the profile. Material and methods PATIENTS AND ORGANISMSFive hundred and fourteen strains of E coli were isolated from a total of 87 patients (85 women and 2 men) attending a urinary infection clinic over a period of three years. Two hundred and sixty strains were from mid-stream specimens of urine (MSU) from patients with a significant bacteriuria (defined as > 1366 copyright.

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